# FORT WORTH DENTAL CARE PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972001048
- **Authorized official:** DR. STEPHEN GATLIN BROGDON DDS (OWNER)
- **Authorized official phone:** (817) 923-4606

## Contact information

- **Practice address:** 3646 GRANBURY RD \# 104, FORT WORTH, TX 76109-3717
- **Practice address phone:** (817) 923-4606
- **Practice address fax:** (817) 923-5593
- **Mailing address:** 3646 GRANBURY RD \# 104, FORT WORTH, TX 76109-3717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 17178 | TX | Yes |

## Other

- **Enumeration date:** 01/24/2018
- **Last updated:** 01/24/2018